| NPI | 1104358563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX T0613) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A167476) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2021-12-23 |